N680 Module 7 assignment: vulnerable population paper, a full sample

Room 114 Is Home: Families With Young Children Living in Motels and a Public Health Nursing Response

Student Name

Master of Science in Nursing Program, Aspen University

N680: Public Health Nursing

Instructor Name

Month Day, Year

Room 114 Is Home: Families With Young Children Living in Motels and a Public Health Nursing Response

Along the highway at the edge of a composite mid-sized county, six motels rent rooms by the week. In many of those rooms live families with children: a mother, two children and an infant in one room with a microwave and a mini refrigerator, paying most of her income to stay there because she cannot raise a deposit and first month's rent for an apartment. These families rarely appear in shelter counts, and many do not describe themselves as homeless. Yet their children face many of the health risks of homelessness. This paper describes the population, examines what the evidence shows about the health of young children who experience homelessness, identifies the barriers these families face, and proposes a public health nursing service designed to reach them.

Defining and Counting the Population

How homelessness is defined determines who is counted. Federal housing programs have traditionally counted people in shelters, transitional housing and places not meant for habitation, and families living in motels at their own expense are often outside those counts. School districts, however, use a broader education definition that includes children living in motels, doubled up with other families because of economic hardship, or in similar temporary arrangements, and districts must identify these students and support their enrollment. In the composite county, the annual point-in-time shelter count identified 41 families with children, while the school districts identified 612 students experiencing homelessness, of whom 188 lived in motels.

The gap matters. Families that are not counted are not planned for, and many of them are not connected to the services, such as home visiting, early intervention and housing assistance, that could help. Over the past quarter century, family homelessness in the United States has grown to include large numbers of children, many of them very young, and those children face serious health and developmental risks (Grant et al., 2013).

Health Risks for Young Children

The evidence on young children is striking. Interviews with 20,571 low-income caregivers of children younger than four, recruited in five U.S. cities, showed that children homeless both before and after birth had higher odds of hospitalization after the newborn period, fair or poor health and developmental delay than children who had never been homeless, after controlling for birth outcomes. Infants homeless for more than six months had about three times the odds of fair or poor health (Sandel et al., 2018). The authors concluded that stabilizing young families quickly in adequate, affordable housing may improve children's health.

Motel life adds specific hazards. Rooms without kitchens push families toward convenience food. With no room for a crib, babies often share the adult bed, raising the risk of sleep-related death. Crowding spreads respiratory and skin infections, and some motels have pests, mold or unsafe wiring. Parents under chronic stress, often working irregular shifts, may miss well-child visits and immunizations, particularly if they have moved between counties and lost track of their child's records.

Barriers to Care

Families living in motels face barriers at every step. Many lack reliable transportation to clinics. Changing addresses break the mailings that remind families of appointments and Medicaid renewals, so coverage lapses. Parents may fear that disclosing their living situation will lead to a child protective services report. Clinic hours conflict with work shifts. And because many families do not identify as homeless, outreach aimed at shelters misses them entirely. Any service designed for this population must go to where the families are, at times they can meet, and must make clear that its purpose is support rather than surveillance.

Motel stays also cut families off from the informal help that stable neighborhoods provide. Parents who move every few weeks lose contact with neighbors who might watch a child during a clinic visit, and children change schools often, so teachers and school nurses have little time to notice a hearing problem or a speech delay before the family moves again.

A Public Health Nursing Response

The proposed service places a public health nurse and a community health worker at the motels two evenings a week, working with the school district's homeless education liaison, who already knows many of the families through their children. The nurse offers well-child checks for infants and toddlers, developmental screening, immunization catch-up using the state registry, safe sleep teaching with portable cribs provided through a hospital partner, and help with Medicaid renewals. The community health worker, who has lived experience of housing instability, helps families apply for food benefits, child care assistance and housing programs. Pregnant women are referred to prenatal care and offered enrollment in the county's nurse home visiting program, which accepts families at any address.

Housing is the central need, and the nurse's role includes advocacy for it. A randomized study of 2,282 families recruited from shelters in 12 communities found that priority access to long-term rent subsidies reduced homelessness and food insecurity and improved other aspects of adult and child well-being compared with usual care, while short-term subsidies and transitional housing with intensive services had little effect (Gubits et al., 2018). The nursing service will therefore track each family's housing applications and bring aggregate data on children's health needs to the county's housing coalition, making the case that rent assistance for families with young children is a child health intervention.

Evaluation

The service will be judged on measures that matter to children: the proportion of children under five with up-to-date immunizations and a developmental screening in the past year, the number of infants with a safe sleep space, continuous Medicaid coverage and, over time, the number of families moving into stable housing. Families will be asked every six months whether the service is useful and respectful, and their answers will guide changes.

Conclusion

Families with young children living in motels are a vulnerable population hidden by the way homelessness is usually counted. The evidence shows that homelessness around the time of birth harms children's health and development, and that long-term rent assistance is the intervention most likely to end it. A public health nursing service that meets families where they live, works with the school liaison and a community health worker, attends to immediate health needs, and advocates with data for housing offers a practical response within the reach of a county health department.

References

Grant, R., Gracy, D., Goldsmith, G., Shapiro, A., & Redlener, I. E. (2013). Twenty-five years of child and family homelessness: Where are we now? American Journal of Public Health, 103(S2), e1-e10. https://doi.org/10.2105/AJPH.2013.301618

Gubits, D., Shinn, M., Wood, M., Brown, S. R., Dastrup, S. R., & Bell, S. H. (2018). What interventions work best for families who experience homelessness? Impact estimates from the Family Options Study. Journal of Policy Analysis and Management, 37(4), 835-866. https://doi.org/10.1002/pam.22071

Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S., Heeren, T., Black, M. M., Casey, P. H., Chilton, M., Cook, J., Cutts, D. B., Rose-Jacobs, R., & Frank, D. A. (2018). Timing and duration of pre- and postnatal homelessness and the health of young children. Pediatrics, 142(4), Article e20174254. https://doi.org/10.1542/peds.2017-4254